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NPI Code Detail

MEDICARE: MINUTECLINIC DIAGNOSTIC OF MICHIGAN PC

MEDICARE: MINUTECLINIC DIAGNOSTIC OF MICHIGAN PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker
2363LF0000XFamily Nurse Practitioner

General Provider Information

NPI Number : 1902848617
Entity Type Code : Organization
Provider Name (Legal Business Name) : MINUTECLINIC DIAGNOSTIC OF MICHIGAN PC
Provider Business Mailing Address
First Line : PO BOX 772
Second Line : MINUTECLINIC CREDENTIALING
City : WOONSOCKET
State : RI
Zip : 02895-0784
Country : US
Telephone Number : 866-389-2727
Fax Number : 401-406-3539
Provider Business Practice Location Address
First Line : 39350 9 MILE RD
Second Line :
City : NORTHVILLE
State : MI
Zip : 48167-9164
Country : US
Telephone Number : 866-389-2727
Fax Number : 401-406-3539
Authorized Official
Title or Position : ADMINISTRATOR
Name : DEBORAH PINCINCE
Credential :
Telephone Number : 401-770-3813
Provider Enumeration Date : 06/10/2006
Last Update Date : 02/26/2024

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